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Orthogeriatrics Current Awareness
Newsletter
April 2015
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Contents Your Friendly Local Librarian… ........................................................................................................... 2
New from Cochrane Library on Orthogeriatrics .................................................................................. 3
New from NICE .................................................................................................................................. 3
New Activity in UptoDate and DynaMed ............................................................................................ 4
Current Awareness Database Articles related to Orthogeriatrics........................................................ 5
Medical ......................................................................................................................................... 5
Patient care and management ..................................................................................................... 12
Psychological ............................................................................................................................... 16
Other ........................................................................................................................................... 18
Journal Tables of Contents............................................................................................................... 21
Bone and Joint Journal (UK) ......................................................................................................... 21
Osteoporosis International .......................................................................................................... 21
Your Friendly Local Librarian… Whatever your information needs, the library is here to help. As your outreach librarian I offer
literature searching services as well as training and guidance in searching the evidence and critical
appraisal – just email me at [email protected]
OUTREACH: Your Outreach Librarian can help facilitate evidence-based practise for all in the
Orthogeriatrics team, as well as assisting with academic study and research. We can help with
literature searching, obtaining journal articles and books, and setting up individual current
awareness alerts. We also offer one-to-one or small group training in literature searching,
accessing electronic journals, and critical appraisal. Get in touch: [email protected]
LITERATURE SEARCHING: We provide a literature searching service for any library member. For
those embarking on their own research it is advisable to book some time with one of the librarians
for a 1 to 1 session where we can guide you through the process of creating a well-focused literature
research and introduce you to the health databases access via NHS Evidence. Please email requests
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New from Cochrane Library on Orthogeriatrics
PROTOCOL: Nerve blocks or no nerve blocks for pain control after electiv hip replacement
(arthroplasty) surgery in adults
Niraj V Kalore , Joanne Guay , Jamie M Eastman , Mina Nishimori and Jasvinder A Singh
Published 25th March 2015
Objectives: We aim to compare the relative effects (benefits and harms) of the different nerve
blocks that may be used to relieve pain after elective hip replacement in adults.
SYSTEMATIC REVIEW: Braces and orthoses for treating osteoarthritis of the knee
Tijs Duivenvoorden , Reinoud W Brouwer , Tom M van Raaij , Arianne P Verhagen , Jan AN Verhaar
and Sita MA Bierma-Zeinstra
Published 16th March 2015
Individuals with osteoarthritis (OA) of the knee can be treated with a knee brace or a foot/ankle
orthosis. The main purpose of these aids is to reduce pain, improve physical function and, possibly,
slow disease progression. This is the second update of the original review published in Issue 1, 2005,
and first updated in 2007. Objectives: To assess the benefits and harms of braces and foot/ankle
orthoses in the treatment of patients with OA of the knee.
New from NICE
Implantation of a shock or load absorber for mild to moderate symptomatic medial knee
osteoarthritis
The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in
England, Wales, Scotland and Northern Ireland on Implantation of a shock or load absorber for mild
to moderate symptomatic medial knee osteoarthritis, in January 2015. Description: Osteoarthritis of
the medial compartment of the knee is the result of progressive deterioration of the articular
cartilage and menisci of the joint. This leads to exposure of the bone surface and chronic excessive
joint loading during movement. Symptoms include joint pain, stiffness, local inflammation, limited
movement and loss of knee function.
Treatment depends on the severity of the osteoarthritis. Conservative treatments include: analgesics
and corticosteroid injections to relieve pain and inflammation; physiotherapy and exercise to
improve function and mobility; and weight loss for people who are overweight or obese, as
recommended in NICE’s guideline on osteoarthritis. When symptoms are severe, surgery may be
indicated. Options include high tibial osteotomy and unicompartmental or total knee arthroplasty.
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New Activity in UptoDate and DynaMed
New updates in point-of-care evidence summarising tools UpToDate and DynaMed.
atypical antipsychotic medication use associated with increased risk of hip fracture in older adults
(level 2 [mid-level] evidence)
based on retrospective cohort study
97,777 adults ≥ 65 years old who received a new outpatient prescription
for quetiapine, risperidone, or olanzapine matched with 97,777 similar persons without
a prescription for atypical antipsychotics and followed for 90 days
atypical antipsychotic medication use associated with increased risk of hip fracture (odds
ratio 1.67, 95% CI 1.53-1.81)
Reference - JAMA Intern Med 2015 Mar 1;175(3):450
combined IV and intra-articular tranexamic acid not associated with reduced blood loss or need
for transfusion compared to IV tranexamic acid alone in patients having total knee arthroplasty
(level 2 [mid-level] evidence)
based on randomized trial with unclear method of randomization and blinding not
stated
184 patients (mean age 65 years, 63.6% female) having unilateral total knee arthroplasty
randomized to tranexamic acid 1.5 g IV plus tranexamic acid 1.5 g intra-articular vs.
tranexamic acid 3 g IV alone
IV tranexamic acid administered just prior to incision, and intra-articular tranexamic acid
dissolved in 50 mL normal saline and irrigated in the wound after implantation of
components
no significant differences in blood loss or blood transfusion
Reference - J Arthroplasty 2014 Dec;29(12):2342
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Current Awareness Database Articles related to
Orthogeriatrics
Below is a selection of articles related to orthogeriatrics recently added to the healthcare
databases, grouped in the following categories:
Medical
Patient care and management
Psychological
Other
If you would like any of the following articles in full text, or if you would like a more focused
search on your own topic, then get in touch: [email protected]
Medical
Title: The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF).
Citation: Archives of gerontology and geriatrics, Mar 2015, vol. 60, no. 2, p. 366-371 (2015 Mar-Apr)
Author(s): Forget, Patrice, Moreau, Nicolas, Engel, Harald, Cornu, Olivier, Boland, Benoît, De Kock,
Marc, Yombi, Jean-Cyr
Abstract: The NLR is a prognostic factor for outcome and survival in cardiology, oncology and
digestive surgery. NLR has not yet been studied in HF. Retrospective analysis of a prospective cohort
of 247 consecutive patients, older than 65years, operated for HF. Mortality at 12months was
registered, as the perioperative NLR values. After hip surgery in the 247 patients (women 71%,
median age 85 years, range: 66-102), the mortality was 27.2% [95%confidence interval (CI): 21.4-
33.0] at 12months. Univariate analysis detected four risk factors for mortality: age (Hazard Ratio
(HR) - by 10year-increments: 2.08 [95%CI: 1.37-3.17], P 5 at day 5 (HR: 1.8 [95%CI: 1.11-2.94],
P=0.002). In multivariate analysis, two factors remained significantly associated with mortality: age
(HR: 2.28 [95%CI: 1.49-3.47], P 5 at day 5 (Odds Ratio (OR): 3.34 [95%CI: 2.33-4.80], P=0.001) and
MCM (OR: 3.04 [95%CI: 2.16-4.29], P=0.006). A higher risk of infection was independently associated
with a NLR > 5 at day 5 (OR: 2.12 [95%CI: 1.44-3.11], P=0.02). The NLR at fifth postoperative day is a
risk factor of postoperative mortality and cardiovascular complications. Copyright © 2014 Elsevier
Ireland Ltd. All rights reserved.
Title: LiDCO-based fluid management in patients undergoing hip fracture surgery under spinal
anaesthesia: a randomized trial and systematic review.
Citation: British journal of anaesthesia, Mar 2015, vol. 114, no. 3, p. 444-459 (March 2015)
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Author(s): Moppett, I K, Rowlands, M, Mannings, A, Moran, C G, Wiles, M D, NOTTS Investigators
Abstract: Hip fracture is a condition with high mortality and morbidity in elderly frail patients.
Intraoperative fluid optimization may be associated with benefit in this population. We investigated
whether intraoperative fluid management using pulse-contour analysis cardiac monitoring,
compared with standard care in patients undergoing spinal anaesthesia, would provide benefits in
terms of reduced time until medically fit for discharge and postoperative complications. Patients
undergoing surgical repair of fractured neck of femur, aged >60 yr, receiving spinal anaesthesia were
enrolled in this single-centre, blinded, randomized, parallel group trial. Patients were allocated to
either anaesthetist-directed fluid therapy or a pulse-contour-guided fluid optimization strategy using
colloid (Gelofusine) boluses to optimize stroke volume. The primary outcome was time until
medically fit for discharge. Secondary outcomes included postoperative complications, mobility, and
mortality. We updated a systematic review to include relevant trials to 2014. We recruited 130
patients. Time until medically fit for discharge was similar in both groups, mean [95% confidence
interval (CI)] 12.2 (11.1-13.5) vs 13.1 (11.9-14.5) days (P=0.31), as was total length of stay 14.2 (12.9-
15.8) vs 15.3 (13.8-17.2) days (P=0.32). There were no significant differences in complications,
function, or mortality. An updated meta-analysis (four studies, 355 patients) found non-significant
reduction in early mortality [relative risk 0.66 (0.24-1.79)] and in-hospital complications [relative risk
0.80 (0.61-1.05)]. Goal-directed fluid therapy during hip fracture repair under spinal anaesthesia
does not result in a significant reduction in length of stay or postoperative complications. There is
insufficient evidence to either support or discount its routine use. ISRCTN88284896. © The Author
2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights
reserved. For Permissions, please email: [email protected].
Title: The curative effect comparison between prolonged third generation of gamma nail and
prolonged dynamic hip screw internal fixation in treating femoral intertrochanteric fracture and
the effect on infection.
Citation: Cell biochemistry and biophysics, Mar 2015, vol. 71, no. 2, p. 695-699 (March 2015)
Author(s): He, Wenye, Zhang, Wei
Abstract: The objective was to explore the curative effect of prolonged third generation of gamma
nail (pTGN) and prolonged dynamic hip screw (pDHS) internal fixation in treating femoral
intertrochanteric fracture, and analyze the incidence rate of infection for better clinical diagnosis
and treatment. Sixty five patients with femoral intertrochanteric fracture during February, 2011-
February, 2013 were selected and divided into two groups, with one receiving pTGN (control group)
and the other one receiving pDHS internal fixation (observation group). The clinical effects of two
groups were compared. In control group, the excellent and good rate was 78.13 %, the total
effective rate was 87.5 %, and the total complication rate was 6.24 %; in observation group, the
excellent and good rate was 78.79 %, the total effective rate was 90.91 %, the total complication
rate was 6.06 %; there was no statistical difference between two groups (p > 0.05). The operation
time, the intraoperative fluoroscopy time, and the total blood loss had statistically significant
difference between two groups (p 0.05). Both pTGN and pDHS internal fixation were effective on
femoral intertrochanteric fracture, with pDHS internal fixation having better overall efficiency.
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Title: Factors that influence soft tissue thickness over the greater trochanter: Application to
understanding hip fractures.
Citation: Clinical anatomy (New York, N.Y.), Mar 2015, vol. 28, no. 2, p. 253-261 (March 2015)
Author(s): Levine, Iris C, Minty, Lauren E, Laing, Andrew C
Abstract: Fall-related hip injuries are a concern for the growing population of older adults. Evidence
suggests that soft tissue overlying the greater trochanter attenuates the forces transmitted to the
proximal femur during an impact, reducing mechanical risk of hip fracture. However, there is limited
information about the factors that influence trochanteric soft tissue thickness. The current study
used ultrasonography and electromyography to determine whether trochanteric soft tissue
thickness could be quantified reproducibly and whether it was influenced by: (1) gender; (2) hip
postures associated with potential falling configurations in the sagittal plane (from 30° of extension
to 60° of flexion, at 15° intervals), combined adduction-flexion, and combined adduction-extension;
and (3) activation levels of the tensor fascia lata (TFL) and gluteus medius (GM) muscles. Our results
demonstrated that soft tissue thickness can be measured reliably in nine hip postures and three
muscle activation conditions (for all conditions, ICC >0.98). Mean (SD) thickness in quiet stance was
2.52 cm. Thickness was 27.0% lower for males than females during quiet stance. It was 16.4%
greater at maximum flexion than quiet standing, 27.2% greater at maximum extension, and 12.5%
greater during combined adduction-flexion. However, there was no significant difference between
combined adduction-extension and quiet standing. Thickness was not affected by changes in muscle
activity. Forces applied to the femoral neck during a lateral fall decrease as trochanteric soft tissue
thickness increases; gender and postural configuration at impact could influence the loads applied to
the proximal femur (and thus hip fracture risk) during falls on the hip. Clin. Anat. 28:253-261, 2015.
© 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
Title: Diabetes confers little to no increased risk of postoperative complications after hip fracture
surgery in geriatric patients.
Citation: Clinical orthopaedics and related research, Mar 2015, vol. 473, no. 3, p. 1043-1051 (March
2015)
Author(s): Golinvaux, Nicholas S, Bohl, Daniel D, Basques, Bryce A, Baumgaertner, Michael R, Grauer,
Jonathan N
Abstract: Diabetes and hip fractures in geriatric patients are common, and many elderly patients
have a history of diabetes. However, the influence of diabetes on surgical complications may vary
based on which particular type of diabetes a patient has. To our knowledge, no prior study has
stratified patients with diabetes to compare patients with noninsulin-dependent and insulin-
dependent diabetes regarding rates of postoperative adverse events, length of hospitalization, and
readmission rate after surgical stabilization of hip fractures in geriatric patients. We asked whether
patients with noninsulin-dependent or insulin-dependent diabetes are at increased risk (1) of
sustaining an aggregated serious adverse event, aggregated minor adverse event, extended length
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of stay, or hospital readmission within 30 days of hip fracture surgery; (2) of experiencing any
individual serious adverse event within 30 days of hip fracture surgery; and (3) of experiencing any
individual minor adverse event within 30 days of hip fracture surgery. Patients older than 65 years
undergoing surgery for hip fracture between 2005 and 2012 were identified (n = 9938) from the
American College of Surgeons National Surgical Quality Improvement Program(®) database. This
database reports events within 30 days of the surgery. Demographics were compared between
three groups of patients: patients with noninsulin-dependent diabetes, patients with insulin-
dependent diabetes, and patients without diabetes. Patients without diabetes served as the
reference group, and the relative risks for aggregated serious adverse events, aggregated minor
adverse events, length of stay greater than 9 days, and readmission within 30 days were calculated
for patients with noninsulin-dependent and with insulin-dependent diabetes. We then calculated
relative risks for each specific serious adverse event and minor adverse event using multivariate
analyses. Patients with noninsulin-dependent and insulin-dependent diabetes were at no greater
risk of sustaining an aggregated serious adverse event, aggregated minor adverse event, extended
postoperative length of stay, or readmission. Among individual serious adverse events, only
postoperative myocardial infarction was found to be increased in the diabetic groups (relative risk
[RR] = 1.9 for noninsulin-dependent diabetes, 95% CI, 1.3-2.8; RR = 1.5 for insulin-dependent
diabetes, CI, 0.9-2.6; p = 0.003). Patients with noninsulin-dependent and insulin-dependent diabetes
were at no greater risk of sustaining any individual minor adverse event. Despite previously reported
and perceived risks associated with diabetes, we found little difference in terms of perioperative risk
among geriatric patients with hip fracture with noninsulin-dependent or insulin-dependent diabetes
relative to patients without diabetes. Clinically, the implications of these findings will help to
improve, specify, and increase the efficiency of the preoperative workup and counseling of patients
with diabetes who need hip fracture surgery. Level III, case-control study. See Instructions for
Authors for a complete description of levels of evidence.
Title: Risk factors for the second contralateral hip fracture in elderly patients: a systematic review
and meta-analysis.
Citation: Clinical rehabilitation, Mar 2015, vol. 29, no. 3, p. 285-294 (March 2015)
Author(s): Liu, Song, Zhu, Yanbin, Chen, Wei, Sun, Tao, Cheng, Jiaxiang, Zhang, Yingze
Abstract: To achieve a quantitative and comprehensive conclusion concerning the risk factors for the
second contralateral hip fracture in elderly patients with initial hip fractures. This search was applied
to Medline, Embase, Cochrane central database (all up to April 2014). All the studies on bilateral hip
fractures in elderly patients published in English were reviewed and qualities of included studies
were assessed using the Newcastle-Ottawa Scale. All the data were carefully and independently
abstracted by two reviewers, any disagreement was settled by discussion. Data was pooled and a
meta-analysis completed. A total of 13 case-control studies were identified for the meta-analysis.
The significant risk factors were female (odds ratio (OR), 1.30; 95% confidence interval (CI), 1.02-
1.64), living in institutions (OR, 2.53; 95% CI, 1.33-4.85), osteoporosis (OR, 10.02; 95% CI, 5.41-
18.57), low vision (OR, 2.09; 95% CI, 1.06-4.12), dementia (OR, 2.02; 95% CI, 1.54-2.65), dizziness
(OR, 2.87; 95% CI, 1.42-5.87) cardiac diseases (OR, 1.33; 95% CI, 1.00-1.78) and respiration diseases
(OR, 2.58; 95% CI, 1.22-5.47). No significant difference was found in admission age between patients
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with the unilateral hip fracture and the first hip fracture of bilateral hip groups (standardized mean
difference, 0.02, 95% CI, -0.30 to 0.35]. Patients involved with female, living in institutions,
osteoporosis, low vision, dizziness, dementia, respiration diseases and cardiac diseases were at risk
for a second contralateral hip fracture after the initial hip fracture. © The Author(s) 2014.
Title: Osteoporosis after renal transplantation.
Citation: International urology and nephrology, Mar 2015, vol. 47, no. 3, p. 503-511 (March 2015)
Author(s): Dounousi, Evangelia, Leivaditis, Konstantinos, Eleftheriadis, Theodoros, Liakopoulos,
Vassilios
Abstract: Bone loss and fracture are serious sequelae of kidney transplantation, associated with
morbidity, mortality and high economic costs. The pathogenesis of post-transplantation bone loss is
multifactorial and complex. Pre-existing bone mineral disease is responsible for a significant part,
but it is aggravated by risk factors emerging after renal transplantation with immunosuppressive
agents being one of the key contributors. The decrease in bone mass is particularly prominent during
the first 6-12 months after transplantation, continuing at a lower rate thereafter. Bone mineral
density measurements do not predict bone histology and bone biopsy findings reveal heterogeneous
lesions, which vary according to time after transplantation. Currently, vitamin D and
bisphosphonates are the most extensively tested therapeutic agents against this accelerated bone
loss in renal transplant recipients. Both of these agents have proven effective, but there is no
evidence that they decrease fracture risk. More studies are needed to examine the complex
pathophysiologic mechanisms implicated in this population, as well as the effects of different
therapeutic interventions on bone disorders after kidney transplantation.
Title: Abdominal obesity increases the risk of hip fracture. A population-based study of 43 000
women and men aged 60-79 years followed for 8 years. Cohort of Norway.
Citation: Journal of internal medicine, Mar 2015, vol. 277, no. 3, p. 306-317 (March 2015)
Author(s): Søgaard, A J, Holvik, K, Omsland, T K, Tell, G S, Dahl, C, Schei, B, Falch, J A, Eisman, J A,
Meyer, H E
Abstract: The question as to whether abdominal obesity has an adverse effect on hip fracture
remains unanswered. The purpose of this study was to investigate the associations of waist
circumference, hip circumference, waist-hip ratio, and body mass index with incident hip fracture.
The data in this prospective study is based on Cohort of Norway, a population-based cohort
established during 1994-2003. Altogether 19,918 women and 23,061 men aged 60-79 years were
followed for a median of 8.1 years. Height, weight, waist and hip circumference were measured at
baseline using standard procedures. Information on covariates was collected by questionnaires. Hip
fractures (n = 1,498 in women, n = 889 in men) were identified from electronic discharge registers
from all general hospitals in Norway between 1994 and 2008. The risk of hip fracture decreased with
increasing body mass index, plateauing in obese men. However, higher waist circumference and
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higher waist-hip ratio were associated with an increased risk of hip fracture after adjustment for
body mass index and other potential confounders. Women in the highest tertile of waist
circumference had an 86% (95% CI: 51-129%) higher risk of hip fracture compared to the lowest,
with a corresponding increased risk in men of 100% (95% CI 53-161%). Lower body mass index
combined with abdominal obesity increased the risk of hip fracture considerably, particularly in men.
Abdominal obesity was associated with an increased risk of hip fracture when body mass index was
taken into account. In view of the increasing prevalence of obesity and the number of older people
suffering osteoporotic fractures in Western societies, our findings have important clinical and public
health implications. © 2014 The Association for the Publication of the Journal of Internal Medicine.
Title: Functional Outcomes After Total Hip Arthroplasty for the Acute Management of Acetabular
Fractures: 1- to 14-Year Follow-up.
Citation: Journal of orthopaedic trauma, Mar 2015, vol. 29, no. 3, p. 151-159 (March 2015)
Author(s): Lin, Carol, Caron, Jason, Schmidt, Andrew H, Torchia, Michael, Templeman, David
Abstract: This study reports the complications and functional outcomes in patients treated acutely
with combined open reduction internal fixation (ORIF) and immediate total hip arthroplasty (THA)
for displaced comminuted acetabular fractures. Single surgeon retrospective case series. Level 1
trauma center. Thirty-three consecutive patients (18 women; mean age, 66 years) from 1996 to
2011 with an average follow-up of 5.6 years (range, 1-14.3 years) were included in this study. ORIF
and immediate THA. Oxford Hip Score and reoperation. All patients had at least 1 year of telephone
or clinical follow-up. Postoperative complications, reoperations, and available radiographs were
reviewed. Six patients died of causes unrelated to their injuries or surgery; before death, these
patients had well-functioning hips. There was a 15% complication rate. At last follow-up, 94% of hips
remained in situ and were functioning well. The average Oxford Hip Score at final follow-up was 17
(range, 12-32), with 93% of patients reporting good to excellent function. There was no statistical
association between fracture type, age, or fixation type and outcome. Acute ORIF and immediate
THA for selected acetabular fractures is a safe viable treatment option with good to excellent
functional outcomes and may reduce the need for 2 separate operations in many patients.
Functional outcomes are equivalent to those after primary THA for osteoarthritis. This study does
not address at which age acute THA is a cost-effective treatment option. Therapeutic Level IV. See
Instructions for Authors for a complete description of levels of evidence.
Title: Modular hip implant fracture at the stem-sleeve interface.
Citation: Orthopedics, Mar 2015, vol. 38, no. 3, p. e234. (March 1, 2015)
Author(s): Parisi, Thomas, Burroughs, Brian, Kwon, Young-Min
Abstract: The use of modular implants in femoral stem design has grown increasingly popular over
the last decade because of the theoretical advantage of more flexibility and optimization of femoral
anteversion, limb length, and femoral component offset. With the benefit of increased surgical
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flexibility, however, modularity also carries the theoretical risks of fretting at the modular surfaces,
sequelae of wear debris, and possible failure and fracture of the stem at the modular junction.
Indeed, there have been an increasing number of reports of modular implants failing due to fracture
at modular junctions. The S-ROM prosthesis (DePuy Orthopaedics, Inc, Warsaw, Indiana), however,
has a stellar clinical record and has been used with good results in both primary and revision total
hip arthroplasty. Only a single case of S-ROM failure at the stem-sleeve interface has been reported
in the orthopedic literature. The aim of this case report was to present a succinct history of proximal
modularity in total hip arthroplasty and to describe the only known case of this type of catastrophic
failure in an S-ROM prosthesis with a metal-on-metal bearing. Despite a low level of serum metal
ions on presentation, scanning electron microscopy showed findings consistent with corrosive
processes and pseudotumor was seen at revision surgery. [Orthopedics. 2015; 38(3):e234-e239.].
Copyright 2015, SLACK Incorporated.
Title: Sliding hip screw versus sliding helical blade for intertrochanteric fractures: a propensity
score-matched case control study.
Citation: The bone & joint journal, Mar 2015, vol. 97-B, no. 3, p. 398-404 (March 2015)
Author(s): Fang, C, Lau, T W, Wong, T M, Lee, H L, Leung, F
Abstract: The spiral blade modification of the Dynamic Hip Screw (DHS) was designed for superior
biomechanical fixation in the osteoporotic femoral head. Our objective was to compare clinical
outcomes and in particular the incidence of loss of fixation. In a series of 197 consecutive patients
over the age of 50 years treated with DHS-blades (blades) and 242 patients treated with
conventional DHS (screw) for AO/OTA 31.A1 or A2 intertrochanteric fractures were identified from a
prospectively compiled database in a level 1 trauma centre. Using propensity score matching, two
groups comprising 177 matched patients were compiled and radiological and clinical outcomes
compared. In each group there were 66 males and 111 females. Mean age was 83.6 (54 to 100) for
the conventional DHS group and 83.8 (52 to 101) for the blade group. Loss of fixation occurred in
two blades and 13 DHSs. None of the blades had observable migration while nine DHSs had gross
migration within the femoral head before the fracture healed. There were two versus four implant
cut-outs respectively and one side plate pull-out in the DHS group. There was no significant
difference in mortality and eventual walking ability between the groups. Multiple logistic regression
suggested that poor reduction (odds ratio (OR) 11.49, 95% confidence intervals (CI) 1.45 to 90.9, p =
0.021) and fixation by DHS (OR 15.85, 95%CI 2.50 to 100.3, p = 0.003) were independent predictors
of loss of fixation. The spiral blade design may decrease the risk of implant migration in the femoral
head but does not reduce the incidence of cut-out and reoperation. Reduction of the fracture is of
paramount importance since poor reduction was an independent predictor for loss of fixation
regardless of the implant being used.
Title: The determinants of mortality and morbidity during the year following fracture of the hip: a
prospective study.
Citation: The bone & joint journal, Mar 2015, vol. 97-B, no. 3, p. 383-390 (March 2015)
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Author(s): Mariconda, M, Costa, G G, Cerbasi, S, Recano, P, Aitanti, E, Gambacorta, M, Misasi, M
Abstract: Several studies have reported the rate of post-operative mortality after the surgical
treatment of a fracture of the hip, but few data are available regarding the delayed morbidity. In this
prospective study, we identified 568 patients who underwent surgery for a fracture of the hip and
who were followed for one year. Multivariate analysis was carried out to identify possible predictors
of mortality and morbidity. The 30-day, four-month and one-year rates of mortality were 4.3%,
11.4%, and 18.8%, respectively. General complications and pre-operative comorbidities represented
the basic predictors of mortality at any time interval (p
Patient care and management
Title: Number of drugs in the medication list as an indicator of prescribing quality: a validation
study of polypharmacy indicators in older hip fracture patients.
Citation: European journal of clinical pharmacology, Mar 2015, vol. 71, no. 3, p. 363-368 (March
2015)
Author(s): Belfrage, Björn, Koldestam, Anders, Sjöberg, Christina, Wallerstedt, Susanna M
Abstract: Indicators based on the number of drugs in the medication list are sometimes used to
reflect quality of drug treatment. This study aimed to evaluate the concurrent validity of such
polypharmacy indicators, i.e., their ability to differentiate between appropriate and suboptimal drug
treatment. In 200 hip fracture patients (≥65 years of age), consecutively recruited to a randomized
controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry
was assessed according to a gold standard as well as to indicators based on the number of drugs in
the medication list. As gold standard, two specialist physicians independently assessed and then
agreed on the quality for each patient, after initial screening with Screening Tool of Older Persons'
potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment
(START). Suboptimal drug treatment was defined as ≥1 STOPP/START outcomes assessed as clinically
relevant at the individual level. A total of 141 (71 %) patients had suboptimal drug treatment
according to the gold standard. The corresponding figures according to the indicators ≥5 and ≥10
drugs were 149 (75) and 49 (25 %), respectively. The sensitivity for the indicators ≥5 and ≥10 drugs
to detect suboptimal drug treatment was 0.86 (95 % confidence interval: 0.80; 0.92) and 0.32 (0.25;
0.40), respectively. The specificity was 0.53 (0.41; 0.65) and 0.93 (0.82; 0.97). The findings suggest
that no polypharmacy indicator could serve as a general indicator of prescribing quality; cut-offs for
such indicators need to be chosen according to purpose.
Title: Management of osteoporosis in rheumatoid arthritis patients.
Citation: Expert opinion on pharmacotherapy, Mar 2015, vol. 16, no. 4, p. 559-571 (March 2015)
Author(s): Hoes, Jos N, Bultink, Irene Em, Lems, Willem F
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Abstract: In rheumatoid arthritis (RA) patients, the risk of both vertebral and non-vertebral fractures
is roughly doubled, which is for an important part caused by inflammation-mediated amplification of
bone loss and by immobilization. New treatments have become available in the last two decades to
treat both RA and osteoporosis. Epidemiology and assessment of osteoporosis and fracture risk
(including the influence of RA disease activity and bone-influencing medications such as
glucocorticoids), the importance of vertebral fracture assessment in addition to bone density
measurement in patients with RA, the use of disease-modifying antirheumatic drugs and their
effects on generalized bone loss, and current and possible future anti-osteoporotic
pharmacotherapeutic options are discussed with special focus on RA. Assessment of osteoporosis in
RA patients should include evaluation of the effects of disease activity and bone-influencing
medications such as (the dose of) glucocorticoids, above standard risk factors for fractures or
osteoporosis as defined by the FRAX instrument. Disease-modifying antirheumatic drugs are now
well able to control disease activity using treat to target strategies. This lowering of disease activity
by antirheumatic medications such as anti-TNF-α results in hampering of generalized bone loss;
however, no fracture data are currently available. When treating osteoporosis in RA patients,
additional focus should be on calcium supplementation, particularly in glucocorticoid users, and also
on sufficient vitamin D use. Several anti-osteoporotic medications are now on the market; oral
bisphosphonates are most commonly used, but in recent years, more agents have entered the
market such as the parenteral antiresorptives denosumab (twice yearly) and zoledronic acid (once
yearly), and the anabolic agent parathyroid hormone analogues. New agents, such as odanacatib
and monoclonal antibodies against sclerostin, are now being tested and will most likely enlarge the
possibilities of osteoporosis treatment in RA patients.
Title: Can Geriatric Hip Fractures be Managed Effectively Within a Level 1 Trauma Center?
Citation: Journal of orthopaedic trauma, Mar 2015, vol. 29, no. 3, p. 160-164 (March 2015)
Author(s): Ling, Shi-Neng James, Kleimeyer, Christopher, Lynch, Genni, Burmeister, Elizabeth,
Kennedy, Diana, Bell, Kate, Watkins, Leith, Cooke, Cameron
Abstract: To determine whether geriatric hip fractures can be managed effectively within a level 1
trauma center. A prospective observational cohort study with a historical control group. Level 1
trauma center. A total of 199 patients admitted under our hip fracture service were prospectively
identified from 2011-2012. These were compared with 191 hip fracture patients who were admitted
before the service. The hip fracture service includes coadmission under an orthopaedic and a
geriatric team. A daily, consultant-led operating list was made available for hip fracture surgery. A
"neck of femur" nurse was employed to coordinate patient care. Time to surgery, length of stay,
discharge destination, and mortality. A cost-benefit analysis and a comparison with a lower acuity
hospital were also performed. Since the hip fracture service, more patients underwent surgery
within 48 hours (67% vs. 52%; P = 0.004), the length of stay significantly decreased from 26 to 22
days (P = 0.004), significantly more patients were admitted to the rehabilitation unit (58.7% vs. 3.5%;
P
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Title: Complications and institutionalization are almost doubled after second hip fracture surgery
in the elderly patient.
Citation: Journal of orthopaedic trauma, Mar 2015, vol. 29, no. 3, p. e103. (March 2015)
Author(s): van der Steenhoven, Tim J, Staffhorst, Bas, Van de Velde, Samuel K, Nelissen, Rob G H H,
Verhofstad, Michiel H J
Abstract: To determine patient and hip fracture characteristics, early postoperative complication
rate, and need for institutionalization at the time of discharge from the hospital in patients treated
for a second contralateral hip fracture. During a 6-year period (2003-2009), 71 patients (60 women
and 11 men; age range, 54-94 years) underwent first hip fracture surgery and subsequent
contralateral hip fracture surgery at our hospital. Variables, including age, gender, American Society
of Anesthesiologists classification (ASA), AO fracture classification, time between both hip fractures,
rate and severity of early postoperative complications, and destination of discharge were obtained
from the electronic medical records. Data from both hospitalization periods were compared. Forty-
six percent of second hip fractures occurred within 2 years after the first hip fracture. After the first
hip fracture surgery, 13 patients had 1 or multiple complications compared with 23 patients after a
second hip fracture surgery (P = 0.02). The mean time (±SD) between the first and second hip
fractures in patients without complications after the second injury was 4.3 (±4.2) years, compared
with 2.6 (±2.1) years in patients with complications after the second injury (P = 0.03). The mean ASA
classification of patients without complications after the second hip fracture surgery was 2.6 (±0.6)
versus 3.0 (±0.6) in patients with complications (P = 0.04). After the first hip fracture surgery, 27
patients (38%) were discharged to an institutional care facility, whereas 72% of patients resided at
an institutional care facility after a second hip fracture. Early complication rate in patients sustaining
a second contralateral hip fracture was almost twice that documented after the first hip fracture.
After the second hip fracture surgery, most patients resided in an institutional care facility.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Title: Hospital readmission after hip fracture.
Citation: Archives of orthopaedic and trauma surgery, Mar 2015, vol. 135, no. 3, p. 329-337 (March
2015)
Author(s): Kates, Stephen L, Behrend, Caleb, Mendelson, Daniel A, Cram, Peter, Friedman, Susan M
Abstract: Readmission to the hospital following a hip fracture is common, often involves an adverse
event, and strains an already overburdened health care system. To assess the rate of 30-day
readmission to the hospital after discharge for care of hip fracture. A secondary objective was
measurement of the 30-day mortality rate for those patients readmitted versus those patients not
readmitted to the hospital after discharge. Study design was a retrospective review of registry data
comparing readmitted patients to those not readmitted after hip fracture. Setting was a university
affiliated level 3 trauma center. 1,081 patients aged 65 and older. rate of readmission, rate of
mortality, predictors of readmission. 129 patients (11.9 %) were readmitted to the hospital within 30
days of their initial discharge date. The primary causes of readmission were surgical in nature for
24/129 (18.6 %) patients and 105/129 (81.4 %) were readmitted for medical or other reasons.
15
Twenty-four (18.6 %) patients who were readmitted died during readmission. The one-year mortality
rate for patients readmitted within 30 days was 56.2 vs. a 21.8 % 1-year mortality rate for those
patients not readmitted (p 85 (OR = 1.52; p = 0.03), time to surgery >24 h (OR = 1.50; p = 0.05),
Charlson score ≥4 (OR = 1.70; p = 0.04), delirium (OR = 1.65; p = 0.01), dementia (OR = 1.61; p =
0.01), history of arrhythmia with pacemaker placement (OR = 1.75; p = 0.02), and presence of a pre-
op arrhythmia (OR = 1.62; p = 0.02). Readmission after hip fracture is harmful and undesirable-18.6
% of readmitted patients died during their readmission and the average length of stay was 8.7 days.
Approximately one of every six readmissions was identified as potentially preventable with
interventions.
Title: Factors affecting delay to surgery and length of stay for patients with hip fracture.
Citation: Journal of orthopaedic trauma, Mar 2015, vol. 29, no. 3, p. e109. (March 2015)
Author(s): Ricci, William M, Brandt, Angel, McAndrew, Christopher, Gardner, Michael J
Abstract: The purpose of this study was to determine factors, including day of week of hospital
admission, associated with delay to surgery (DTS) and increased length of stay (LOS) in patients with
hip fractures. Retrospective. Level I Trauma Center. Six hundred thirty-five consecutive patients
admitted to a single hospital between January 1999 and July 2006 aged 65 years or older with a hip
fracture (OTA 31) were identified retrospectively from an orthopaedic database. Demographic data,
American Society of Anesthesiologists (ASA) score, hospital admission and discharge dates, the date
of surgery, and details of any preoperative cardiac testing were extracted from the hospital record.
These data were used to identify the day of week for hospital admission and to calculate days for
DTS and hospital LOS. Linear regression was used to identify independent variables associated with
DTS and increased LOS. All patients underwent surgical treatment of a hip fracture (OTA 31). Factors
affecting DTS and LOS. Independent factors associated with DTS included the day of week for
hospital admission, ASA score, and the need for preoperative cardiac testing. Patients admitted
Thursday through Saturday had longer DTS (mean, 2.2-2.7 days) than did patients admitted other
days (mean, 1.7-1.8). DTS increased for increasing ASA: 1.4 days for ASA 2, 2.0 days for ASA 3, and
3.0 days for ASA 4. Those requiring preoperative cardiac testing had an increased number of days to
surgery (mean, 3.2 days) than those without (mean, 1.7 days). Independent factors associated with
increasing hospital LOS included ASA, the need for preoperative cardiac testing, male gender, and
day of admission. LOS increased for increasing ASA: 6.3 days for ASA 2, 8.1 days for ASA 3, and 10.1
days for ASA 4. Those requiring preoperative cardiac testing had an increased LOS (mean, 9.4 days)
than those without (mean, 7.3 days). Male patients had a longer LOS (mean, 9.8 days) than did
females (mean, 7.3 days). Patients admitted on Thursday or Friday (mean, 8.5-9.1 days) had longer
LOS than those admitted on other days (mean, 7.3-7.9 days). This is the first study to consider and
identify the day of admission and need for preoperative cardiac tests as determinants of DTS and
LOS for geriatric patients with hip fracture. Relative scarcity of weekend hospital resources, when
present, may be responsible for these delays. This study also confirms that patient medical condition
as measured by ASA affects both DTS and LOS. Prognostic Level II. See Instructions for Authors for a
complete description of levels of evidence.
16
Title: Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis
of 8434 patients.
Citation: Journal of orthopaedic trauma, Mar 2015, vol. 29, no. 3, p. e115. (March 2015)
Author(s): Basques, Bryce A, Bohl, Daniel D, Golinvaux, Nicholas S, Leslie, Michael P, Baumgaertner,
Michael R, Grauer, Jonathan N
Abstract: To identify factors associated with increased postoperative length of stay (LOS) and
readmission after surgical repair of geriatric hip fractures. Patients aged 70 years and older who
underwent hip fracture surgery from January 2011 through December 2012 were identified in the
American College of Surgeons National Surgical Quality Improvement Program database. Patient
characteristics were tested for association with postoperative LOS and readmission using bivariate
and multivariate analyses. For the 8434 patients with hip fracture identified, the average age was
83.8 ± 5.9 years (mean ± SD), and 26.9% were male. Average postoperative LOS was 5.6 ± 6.0 days.
Ten percent were readmitted within the first 30 postoperative days. Increased postoperative LOS of
at least 1 full day was associated with increased time from admission to surgery, non-general
anesthesia, and procedure type on multivariate analysis. Readmission was associated with increased
age, male sex, body mass index ≥35 kg/m, American Society of Anesthesiologists class ≥3, pulmonary
disease, hypertension, steroid use, dependent functional status, and discharge to a facility on
multivariate analysis. Ten percent of patients were readmitted after hip fracture repair in this
national sample. Preoperative time to surgery, anesthesia type, and implant selection are 3 risk
factors for increased LOS that can potentially be modified. A clinically significant risk factor for
readmission was body mass index ≥35 kg/m, which was not associated with increased postoperative
LOS. The identified risk factors illuminate opportunities for optimizing care for hip fracture patients
aged 70 and older. Prognostic Level II. See Instructions for Authors for a complete description of
levels of evidence.
Psychological
Title: Severity of cognitive impairment as a prognostic factor for mortality and functional recovery
of geriatric patients with hip fracture.
Citation: Geriatrics & gerontology international, Mar 2015, vol. 15, no. 3, p. 289-295 (March 2015)
Author(s): Tarazona-Santabalbina, Francisco José, Belenguer-Varea, Ángel, Rovira Daudi, Eduardo,
Salcedo Mahiques, Enmanuel, Cuesta Peredó, David, Doménech-Pascual, Juan Ramón, Gac Espínola,
Homero, Avellana Zaragoza, Juan Antonio
Abstract: To identify how the severity of dementia influences functional recovery and mortality in
elderly patients hospitalized for hip fracture. An observational retrospective study of 1258 patients
aged older than 69 years and diagnosed with hip fracture who received care within an
orthogeriatrics unit from 2004 to 2008 was carried out. During a 12-month follow-up period,
functional recovery and mortality outcomes were measured. Dementia was present in 383 (28.1%)
patients: it was mild in 183 (48%), moderate in 102 (26.5%) and severe in 98 (25.5%). Compared with
17
patients with preserved cognitive status, patients with dementia had the following statistically
significant differences (means [standard deviation] or percentage): older age (preserved, 82.29 years
[6.5 years]; mild, 83.63 years [6.1 years]; moderate, 83.47 years [5.9 years]; severe, 84.46 years [6.1
years]; P
Title: Factors associated with short-term functional recovery in elderly people with a hip fracture.
Influence of cognitive impairment.
Citation: Journal of the American Medical Directors Association, Mar 2015, vol. 16, no. 3, p. 215-220
(March 2015)
Author(s): Uriz-Otano, Francisco, Uriz-Otano, Juan Isidro, Malafarina, Vincenzo
Abstract: To assess factors associated with functional recovery and determine the influence of
cognitive impairment. Prospective cohort study. Orthogeriatric rehabilitation ward. A total of 314
older adults (≥65 years) admitted for rehabilitation after a hip operation. Patients were stratified
according to the Mini Mental State Examination into the following categories: severe cognitive
impairment, scores 0 to 15; mild cognitive impairment, scores 16 to 23; and no cognitive
impairment, scores ≥24. Their functional status, in terms of activities of daily living (ADLs), was
recorded, and their ability to walk was measured with the Functional Ambulation Categories at 3
points in time: basal, on admission, and on discharge. We considered recovery of ADLs and ability to
walk to be positive responses to rehabilitation treatment. Of the patients included, 285 finished the
study (16 patients were moved to another hospital and 13 patients died) and 280 received
rehabilitation treatment, with all 3 groups achieving functional gain (P
Title: Recovery of health-related quality of life in a United Kingdom hip fracture population: the
Warwick Hip Trauma Evaluation - a prospective cohort study.
Citation: The bone & joint journal, Mar 2015, vol. 97-B, no. 3, p. 372-382 (March 2015)
Author(s): Griffin, X L, Parsons, N, Achten, J, Fernandez, M, Costa, M L
Abstract: Hip fracture is a global public health problem. The National Hip Fracture Database provides
a framework for service evaluation in this group of patients in the United Kingdom, but does not
collect patient-reported outcome data and is unable to provide meaningful data about the recovery
of quality of life. We report one-year patient-reported outcomes of a prospective cohort of patients
treated at a single major trauma centre in the United Kingdom who sustained a hip fracture between
January 2012 and March 2014. There was an initial marked decline in quality of life from baseline
measured using the EuroQol 5 Dimensions score (EQ-5D). It was followed by a significant
improvement to 120 days for all patients. Although their quality of life improved during the year
after the fracture, it was still significantly lower than before injury irrespective of age group or
cognitive impairment (mean reduction EQ-5D 0.22; 95% confidence interval (CI) 0.17 to 0.26). There
was strong evidence that quality of life was lower for patients with cognitive impairment. There was
a mean reduction in EQ-5D of 0.28 (95% CI 0.22 to 0.35) in patients
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Other
Title: Budget impact analysis of warfarin reversal therapies among hip fracture patients in Finland.
Citation: Drugs in R&D, Mar 2015, vol. 15, no. 1, p. 155-162 (March 2015)
Author(s): Purmonen, Timo, Törmälehto, Soili, Säävuori, Niina, Kokki, Hannu
Abstract: Hip fractures require operation within 36-48 h, and they are most common in the elderly.
A high International Normalized Ratio should be corrected before surgery. In the current study, we
analyzed the budget impact of various warfarin reversal approaches. Four reversal strategies were
chosen for the budget impact analysis: the temporary withholding of warfarin, administration of
vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC). We
estimated that, annually, 410 hip fracture patients potentially require warfarin reversal in Finland.
The least costly treatment was vitamin K, which accounted for 289,000 in direct healthcare costs,
and the most costly treatment option was warfarin cessation, which accounted for 1,157,000. In the
budget impact analysis, vitamin K, PCC and FFP would be cost-saving to healthcare compared with
the current treatment mix. The various warfarin reversal strategies have different onset times, which
may substantially impact the subsequent healthcare costs.
Title: Length of sick leave as a risk marker of hip fracture: a nationwide cohort study from Sweden.
Citation: Osteoporosis international : a journal established as result of cooperation between the
European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Mar
2015, vol. 26, no. 3, p. 943-949 (March 2015)
Author(s): Stenholm, S, Vahtera, J, Kjeldgård, L, Kivimäki, M, Alexanderson, K
Abstract: Sickness absence is a risk marker for future health outcomes, but no previous studies have
examined its association with osteoporotic fractures in old age. The results of this prospective
population-based cohort study based on Swedish registers suggest that sickness absence is
associated with higher risk of hip fracture. Number of sick leave days is a risk marker for future
health outcomes, but few studies have examined its association with major public health concerns in
old age, such as osteoporotic fractures. The aim of this prospective, nationwide, population-based
cohort study based on Swedish registers was to investigate the association between number of sick
leave days and future risk of hip fracture. Participants included were all 983,244 individuals who
were living in Sweden on 31 December 1995, aged 50 to 64 years, employed, and with no previous
hip fracture. Those with sick leave days in 1995 were compared to those with no sickness absence.
Incidence of hip fracture was followed from 1996 to 2010. According to Cox regression models
adjusted for sociodemographic factors and morbidity, being on sick leave more than 3 months,
irrespective of cause, was associated with a 2.0-fold (hazard ratio (HR) 1.96, 95 % confidence interval
(CI) 1.74-2.20) and 1.4-fold (HR 1.40, 95 % CI 1.27-1.56) increased risk of hip fracture in men and
women, respectively. Analyses repeated among those with previous non-hip fractures replicated the
19
significant associations. This nationwide cohort study suggests that sickness absence in working-age
women and men is a risk marker of hip fracture at old ages.
Title: Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation
of femoral neck fracture.
Citation: Osteoporosis international : a journal established as result of cooperation between the
European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Mar
2015, vol. 26, no. 3, p. 1109-1117 (March 2015)
Author(s): Sebestyén, A, Mester, S, Vokó, Z, Gajdácsi, J, Cserháti, P, Speer, G, Patczai, B, Warta, V,
Bódis, J, Horváth, C, Boncz, I
Abstract: The study demonstrates that wintertime surgeries are associated with impaired fracture
healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck
fracture. Furthermore, the results raise the possibility of association between seasonal changes in
vitamin D levels and impaired fracture healing of femoral neck fracture. Although the changes of
vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of
seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on
conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture. This
nationwide retrospective observational cohort study involved 2779 patients aged ≥60 years who
underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000.
Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian
health insurance database were registered. Risk factors assessed included sex, age, fracture type,
season of primary surgery and surgical delay. Competing-risks regression analysis was used for data
analyses. During the observation period, 190 conversions to hip arthroplasty (6.8 %) were identified,
yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions
after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000
person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement,
wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter,
hazard ratio (HR): 0.50, 95 % confidence interval [95 % CI 0.33-0.76]; spring vs. winter, HR: 0.63, [95
% CI 0.44-0.92]; summer vs. winter, HR: 0.62, [95 % CI 0.42-0.91]). Our study demonstrate that
wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help
improving the outcome of primary fixation of femoral neck fractures.
Title: Are low-energy open ankle fractures in the elderly the new geriatric hip fracture?
Citation: The Journal of foot and ankle surgery : official publication of the American College of Foot
and Ankle Surgeons, Mar 2015, vol. 54, no. 2, p. 203-206 (2015 Mar-Apr)
Author(s): Toole, William P, Elliott, Mark, Hankins, David, Rosenbaum, Corey, Harris, Anthony,
Perkins, Christopher
20
Abstract: As the geriatric population in the United States continues to increase, ankle fractures in
the elderly are predicted to exponentially increase in the future. As such, these injuries will become
a common injury seen by physicians in various fields. Currently, no studies discussing low-energy
open ankle fractures in the elderly and/or the mortality rate associated with these devastating
injuries have been published. The purpose of the present study was to retrospectively review the
morality rate associated with low-energy open ankle fractures in the elderly. We retrospectively
identified 11 patients >60 years old who had sustained low-energy open ankle fractures and been
treated at our institution. The patient demographics, mechanism of injury, wound size, medical
comorbidities, treatment, follow-up data, and outcomes were recorded. Low-energy falls were
defined as ground level falls from sitting or standing. The mean age of the patients was 70.72 years,
with a mean body mass index of 35.93 ± 10.24. Of the 11 patients, 9 (81.81%) had ≥3 comorbidities
(i.e., hypertension, diabetes, coronary artery disease, congestive heart failure, and/or chronic
obstructive pulmonary disease). The mean size of the medially based ankle wound was 14.18 ± 4.12
cm; 10 (90.90%) were Gustilo and Anderson grade IIIA open ankle fractures. In our study, low-energy
open ankle fractures in the elderly, very similar to hip fractures, were associated with a high
mortality incidence (27.27%) at a mean of 2.67 ± 2.02 months, and 81.81% of our patients had ≥3
medical comorbidities. Copyright © 2015 American College of Foot and Ankle Surgeons. Published
by Elsevier Inc. All rights reserved.
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Journal Tables of Contents
The most recent issues of the following journals:
Bone and Joint Journal (UK)
Osteoporosis International
Click on the journal covers for the most recent tables of contents. If you would like any of the
papers in full text then get in touch: [email protected]
Bone and Joint Journal (UK)
Vol. 97-B, iss. 4, April 2015
Osteoporosis International
Vol. 26, iss. 4, April 2015
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